Perinatal risk factors for severe injury in neonates treated with whole-body hypothermia for encephalopathy.

OBJECTIVE: Our objective was to identify perinatal risk factors that are available within 1 hour of birth that are associated with severe brain injury after hypothermia treatment for suspected hypoxic-ischemic encephalopathy. STUDY DESIGN: One hundred nine neonates at ≥35 weeks' gestation who were admitted from January 2007 to September 2012 with suspected hypoxic-ischemic encephalopathy were treated with whole-body hypothermia; 98 of them (90%) underwent brain magnetic resonance imaging (MRI) at 7-10 days of life. Eight neonates died before brain imaging. Neonates who had severe brain injury, which was defined as death or abnormal MRI results (cases), were compared with surviving neonates with normal MRI (control subjects). Logistic regression models were used to identify risk factors that were predictive of severe injury. RESULTS: Cases and control subjects did not differ with regard to gestational age, birthweight, mode of delivery, or diagnosis of nonreassuring fetal heart rate before delivery. Cases were significantly (P < .05) more likely to have had an abruption, a cord and neonatal arterial gas level that showed metabolic acidosis, lower platelet counts, lower glucose level, longer time to spontaneous respirations, intubation, chest compressions in the delivery room, and seizures. In multivariable logistic regression, lower initial neonatal arterial pH (P = .004), spontaneous respiration at >30 minutes of life (P = .002), and absence of exposure to oxytocin (P = .033) were associated independently with severe injury with 74.3% sensitivity and 74.4% specificity. CONCLUSION: Worsening metabolic acidosis at birth, longer time to spontaneous respirations, and lack of exposure to oxytocin correlated with severe brain injury in neonates who were treated with whole-body hypothermia. These risk factors may help quickly identify neonatal candidates for time-sensitive investigational therapies for brain neuroprotection.

Assessment of health-related quality of life 6 years after childhood cochlear implantation.

PURPOSE: To examine the impact of cochlear implant (CI) intervention on health-related quality of life (HRQOL) assessed by both self- and parent-reported measures. METHODS: In this national study of children implanted between ages 6 months and 5 years, HRQOL of 129 children 6-year post-CI was compared to 62 internal study (NH1) and 185 external (NH2) samples of hearing children frequency-matched to the CI group on sociodemographic variables. HRQOL ratings of children and their parents in each group, measured using the Child Health and Illness Profile-Child Edition, were compared, and their associations with the Family Stress Scale were investigated. RESULTS: CI children reported overall and domain-specific HRQOL that was comparable to both NH1 and NH2 peers. CI parents reported worse child scores than NH1 parents in Achievement, Resilience, and Global score (p's < 0.01) but similar or better scores than socioeconomically comparable NH2 parents. Higher family stress was negatively associated with all parent-reported HRQOL outcomes (p's < 0.01). Parent-child correlations in HRQOL global scores trended higher in CI recipients (r = 0.50) than NH1 (r = 0.42) and NH2 (r = 0.35) controls. CONCLUSIONS: CI recipients report HRQOL comparable to NH peers. These results, from both child and parent perspective, lend support to the effectiveness of CI intervention in mitigating the impact of early childhood deafness. Family stress was associated with worse HRQOL, underscoring a potential therapeutic target. Parent-child agreement in HRQOL scores was higher for CI families than NH families, which may reflect higher caregiver insight and involvement related to the CI intervention.

Titanium mineralization in ferritin: a room temperature nonphotochemical preparation and biophysical characterization.

The incremental addition of titanium(III) citrate to H-chain homopolymers of human ferritin results in the formation of 1.5-6.5-nm particles of amorphous TiO(2) within the nanocage of the protein. The mineralization conditions are mild, featuring ambient temperature and no need for photochemical activation. Low ratios of titanium to protein favor intraprotein mineralization, and the products are characterized by stained and unstained transmission electron microscopy, UV-vis spectroscopy, dynamic light scattering, analytical ultracentrifugation, and metal analysis. With up to 1,000 equiv of metal, there is no change to the protein hydrodynamic radius or diffusion constant. There is, however, a systematic shift in the sedimentation coefficient, which confirms mineralization within the protein core.

Timing of cochlear implantation and parents' global ratings of children's health and development.

OBJECTIVE: To assess children's health-related quality of life (HRQL) and development after cochlear implant (CI) surgery and compare improvements between different age of implantation categories. STUDY DESIGN: Prospective, longitudinal study comparing outcomes of deaf children post-CI with hearing controls. SETTING: Six US CI centers. PATIENTS: Deaf children who received CI (n = 188) and hearing children of comparable ages (n = 97). INTERVENTION: CI before 5 years of age. MAIN OUTCOME MEASURE: Parental ratings of global HRQL and development, as assessed over the first 4 years of follow-up using visual analog scales. Development scores assess parental views of children's growth and development, motor skills, ability to express themselves and communicate with others, and learning abilities. Associations of baseline child and family characteristics with post-CI HRQL and development were investigated using multivariable analysis, controlling for factors that influence post-CI language learning. RESULTS: Baseline deficits of CI candidates relative to hearing controls were larger in development than HRQL. Development scores improved significantly by 4 years after CI, particularly in the youngest CI recipients. Developmental deficits of older CI recipients with early, extended hearing aid use were only partially remediated by CI. Overall, no significant health deficits were observed in CI children after 4 years. Cognition and speech recognition were positively associated with both HRQL and development. CONCLUSION: Parental perspectives on quality of their child's life and development provide practical insight into the optimal timing of interventions for early-onset deafness. Validity of parental global assessments is supported by clinical measures of speech perception and language learning and comparison with a well-validated health status instrument.